Med Surg (part 3)
4
A nurse is obtaining an admission history for a client who is scheduled for surgery to repair a ruptured abdominal aneurysm. Which type of shock should the nurse monitor for in this client? 1 Obstructive 2 Neurogenic 3 Cardiogenic 4 Hypovolemic
2
A client with a diagnosis of anemia is receiving packed red blood cells. What is the most important action by the nurse when administering the transfusion? 1 Warning the client about the possibility of fluid overload 2 Monitoring the client's response, particularly within the first 10 minutes 3 Adjusting the client's transfusion flow rate so that it infuses at a consistent rate during the procedure 4 Having the client tested for human immunodeficiency virus (HIV) before administering the blood transfusion
4
A client is seen in the clinic with sickle cell anemia. The parents of the client ask how their child got sickle cell anemia. What is an accurate explanation? 1 Sickle cell anemia is a random condition with no known cause. 2 If one parent is a carrier and one is negative for the gene, the child will get the disease. 3 If both parents are carriers, all of their offspring will probably get this disease, and they should consider sterilization. 4 If both parents are carriers, the odds are one in four that an offspring will get the disease, and one in four that an offspring will be disease free.
4
A client undergoes a bowel resection. When assessing the client 4 hours postoperatively, the nurse identifies which finding as an early sign of shock? 1 Respirations of 10 2 Urine output of 30 mL/hour 3 Lethargy 4 Restlessness
3
A client who has been experiencing chest pain and vomiting for several hours is admitted to the hospital with a diagnosis of myocardial infarction. The client is transferred immediately to the cardiac intensive care unit. The client's potassium level is below the expected range. Considering this laboratory result, what should the nurse monitor the client's electrocardiogram (ECG) for? 1 Tall, peaked P waves 2 Increased P-R intervals 3 Elevated U and flattened T waves 4 Multiple trigeminy and bigeminy runs
3
A client who is hospitalized after a myocardial infarction asks the nurse why morphine was prescribed. What will the nurse include in the reply? 1 Decreases anxiety and promotes sleep 2 Helps prevent development of atrial fibrillation 3 Relieves pain and reduces cardiac oxygen demand 4 Dilates coronary blood vessels to increase oxygen supply
1,2,3,4
A client who sustained serious burns now has a stress ulcer. Which clinical indicators of shock should the nurse immediately report to the primary healthcare provider? Select all that apply. 1 Weakness 2 Diaphoresis 3 Tachycardia 4 Cold extremities 5 Flushed skin tone
2
A client with upper gastrointestinal (GI) bleeding develops mild anemia. What should the nurse expect to be prescribed for this client? 1 Dextran 2 Iron salts 3 Vitamin B12 4 Erythropoietin
3
A nurse providing care to a client who had major abdominal surgery monitors the client for postoperative complications. Which clinical findings are indicators of impending hypovolemic shock? 1 Diuresis, irritability, and fever 2 Lethargy, cold skin, and hypertension 3 Thirst, cool skin, and orthostatic hypotension 4 Bounding pulse, restlessness, and slurred speech
3
When caring for a client with venous insufficiency, the nurse would implement which nursing measure? 1 Apply abdominal girdle as needed. 2 Remove compression stockings for client ambulation. 3 Elevate the client's legs above heart level. 4 Keep the upper extremities elevated.
4
Sublingual nitroglycerin is prescribed for a client with a history of a myocardial infarction and atrial tachycardia. The nurse instructs the client about the prophylactic use of these tablets. Which statement by the client indicates the teaching was effective? 1 "I should take the medicine three times a day." 2 "I will be sure to take my pulse after I have exercised." 3 "It will be important to avoid activities that are too strenuous." 4 "I should take one tablet before attempting to climb two flights of stairs."
3
The nurse is caring for a client admitted with shock secondary to severe gastrointestinal bleeding. Once the client is stabilized, what intervention should the nurse do next? 1 Monitor the peripheral pulses. 2 Check the level of consciousness. 3 Take a blood sample for laboratory tests. 4 Control the bleeding with a pressure dressing.
1,5
The nurse is caring for a client who had a massive myocardial infarction and developed cardiogenic shock. Which clinical manifestations support these diagnoses? Select all that apply. 1 Rapid pulse 2 Deep respirations 3 Warm, flushed skin 4 Increased blood pressure 5 Decreased urinary output
2
The nurse is caring for a client with an abdominal aortic aneurysm before surgery. Which nursing care is essential preoperatively? 1 Administering supplemental oxygen 2 Maintaining a reduced blood pressure 3 Keeping the client in a supine position 4 Monitoring the peripheral vascular status
2
A client is in cardiogenic shock. Which explanation of cardiogenic shock should the nurse include when responding to a family member's questions about the condition? 1 An irreversible phenomenon 2 A failure of the circulatory pump 3 Usually a fleeting reaction to tissue injury 4 Generally caused by decreased blood volume
3
A client with a long history of cardiovascular problems, including angina and hypertension, is scheduled to have a cardiac catheterization. During preprocedure teaching, what does the nurse explains to the client is the major purpose for catheterization? 1 To obtain the pressures in the heart chambers 2 To determine the existence of congenital heart disease 3 To visualize the disease process in the coronary arteries 4 To measure the oxygen content of various heart chambers
2
A client with angina pectoris is scheduled for a stress echocardiogram. What should the nurse tell the client that an echocardiogram is? 1 A tool used solely to determine the cause of chest pain 2 A noninvasive approach to assess cardiovascular status 3 A modality of minimal value in planning treatment for angina 4 An invasive test that measures the body's reaction to progressive increases in exertion
4
A nurse has difficulty palpating the pedal pulse of a client with venous insufficiency. What action should the nurse take next? 1 Count the pulse at another site. 2 Notify the primary healthcare provider. 3 Lower the legs to increase blood flow. 4 Verify the pulse by using a Doppler
1,2
A nurse is teaching a group of clients about risk factors for heart disease. Which factors will the nurse include that increase a client's risk for a myocardial infarction (MI)? Select all that apply. 1 Obesity 2 Hypertension 3 Diabetes insipidus 4 Asian-American ancestry 5 Increased high-density lipoprotein (HDL)
2
The nurse teaching a health awareness class identifies which situation as being the highest risk factor for the development of a deep vein thrombosis (DVT)? 1 Pregnancy 2 Inactivity 3 Aerobic exercise 4 Tight clothing
1
The student nurse demonstrates correct understanding of anemia related to chronic disease with which statement? 1 "Red blood cells appear normal in size and color; however, there is a decreased amount produced." 2 "The red blood cells have an increased life span with a decrease in normal functioning." 3 "Administration of vitamins B12 and folate will help to treat this type of long-term anemia." 4 "This is the mildest form of anemia and is easily corrected through administration of blood products."
4
What does a nurse who is caring for a client experiencing anginal pain expect to observe about the pain? 1 Unchanged by rest 2 Precipitated by light activity 3 Described as a knifelike sharpness 4 Relieved by sublingual nitroglycerin
3
What instructions about the use of nitroglycerin should the nurse provide to a client with angina? 1 "Identify when pain occurs, and place two tablets under the tongue." 2 "Place one tablet under the tongue, and swallow another when pain is intense." 3 "Before physical activity, place one tablet under the tongue, and repeat the dose in 5 minutes if pain occurs." 4 "Place one tablet under the tongue when pain occurs, and use an additional tablet after the attack to prevent recurrence."
2
While a client with an abdominal aortic aneurysm is being prepared for surgery, the client complains of feeling light-headed. The client is pale and has a rapid pulse. What does the nurse conclude that the client's symptoms indicate? 1 Hyperventilation 2 Shock 3 Anxiety 4 Infection
1
What is the priority nursing action when caring for a client receiving nitroglycerin for the treatment of angina? 1 Asking the client to sit or stand slowly 2 Monitoring the client's urine output frequently 3 Advising the client to report when experiencing a headache 4 Reporting to the healthcare provider if pain does not subside after 5 minutes
3
Which diagnostic study is used to detect deep vein thrombosis in the client's lower extremities? 1 Thermography 2 Plethysmography 3 Duplex venous doppler 4 Somatosensory evoked potential
2
A client arrives at the emergency room complaining of chest pain and dizziness. The client has a history of angina. The primary healthcare provider prescribes an electrocardiogram (ECG) and lab tests. A change in which component of the ECG tracing should the nurse recognize as the client actively having a myocardial infarction (MI)? 1 QRS complex 2 S-T segment 3 P wave 4 R wave
1
A client is admitted to the coronary care unit with a tentative diagnosis of myocardial infarction. How does the nurse expect the client to describe the pain? 1 Severe, intense chest pain 2 Burning sensation of short duration 3 Mild chest pain, radiating to the fingers 4 Squeezing chest pain, relieved by nitroglycerin
4
A client is admitted to the hospital with a diagnosis of deep vein thrombosis, and intravenous (IV) heparin sodium is prescribed. If the client experiences excessive bleeding, what should the nurse be prepared to administer? 1 Vitamin K 2 Oprelvekin 3 Warfarin sodium 4 Protamine sulfate
4
A client is admitted with the diagnosis of possible myocardial infarction, and a series of diagnostic tests are prescribed. Which blood level should the nurse expect will increase first if this client has had a myocardial infarction? 1 Alanine aminotransferase (ALT) 2 Serum aspartate aminotransferase (AST) 3 Total lactate dehydrogenase (LDH) 4 Troponin T (cTnT)
4
A client is diagnosed with multiple myeloma. What does the nurse expect the plan of care to include? 1 Radiotherapy on an outpatient basis 2 Human leukocyte interferon therapy 3 Surgery to remove the invasive lesions 4 Chemotherapy employing a combination of drugs
2
A client is experiencing a myocardial infarction. What should the nurse identify as the primary cause of the pain experienced by a client with a coronary occlusion? 1 Arterial spasm 2 Heart muscle ischemia 3 Blocking of the coronary veins 4 Irritation of nerve endings in the cardiac plexus
4,5
A client who was admitted with a diagnosis of acute lymphoblastic leukemia is receiving chemotherapy. Which assessment findings should alert the nurse to the possible development of the life-threatening response of thrombocytopenia? Select all that apply. 1 Fever 2 Diarrhea 3 Headache 4 Hematuria 5 Ecchymosis
2
A nurse assesses a client who is experiencing profound (late) hypovolemic shock. When monitoring the client's arterial blood gas results, which response does the nurse expect? 1 Hypokalemia 2 Metabolic acidosis 3 Respiratory alkalosis 4 Decreased carbon dioxide level
1
The nurse is completing an assessment on a couple seeking genetic counseling for sickle cell anemia. Both prospective parents carry sickle cell traits. The nurse recognizes that the couple has what chance of having a child who develops the disease? 1. 25% 2. 50% 3. 75% 4. 100%
3
To prevent septic shock in the hospitalized client, what should the nurse do? 1 Maintain the client in a normothermic state. 2 Administer blood products to replace fluid losses. 3 Use aseptic technique during all invasive procedures. 4 Keep the critically ill client immobilized to reduce metabolic demands
3
Two days after a myocardial infarction, a client has a temperature of 100.2° F (37.9° C). What should the nurse do first? 1 Auscultate the chest for diminished breath sounds. 2 Encourage coughing and deep breathing every hour. 3 Record the temperature reading and continue to monitor it. 4 Suspect an infection and notify the healthcare provider immediately.
1
What is the most definitive test to confirm a diagnosis of multiple myeloma? 1 Bone marrow biopsy 2 Serum test for hypercalcemia 3 Urine test for Bence Jones protein 4 X-ray films of the ribs, spine, and skull
